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Antidepressant drug use in general practice: inter-practice variation and association with practice characteristics.

https://arctichealth.org/en/permalink/ahliterature45928
Source
Eur J Clin Pharmacol. 2003 Jun;59(2):143-9
Publication Type
Article
Date
Jun-2003
Author
Dorte Gilså Hansen
Jens Søndergaard
Werner Vach
Lars Freng Gram
Jens-Ulrik Rosholm
Jakob Kragstrup
Author Affiliation
Research Unit of General Practice, University of Southern Denmark, Winsløwparken 19, DK-5000, Odense C, Denmark. dgilsaa@health.sdu.dk
Source
Eur J Clin Pharmacol. 2003 Jun;59(2):143-9
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Antidepressive Agents - classification - therapeutic use
Comparative Study
Databases, Factual
Denmark
Depressive Disorder - drug therapy
Drug Utilization - statistics & numerical data
Female
Humans
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Physicians, Family - statistics & numerical data
Research Support, Non-U.S. Gov't
Sex Factors
Abstract
OBJECTIVE: The use of antidepressants (ADs) has escalated and prompted considerable debate. Many depressed patients go unrecognised or under-treated and the area of indication of the new ADs is widening. The aim of this study was to analyse (i). the variation in general practitioners' prescribing of ADs by comparing with prescribing of other drug groups and (ii). whether the general prescribing behaviour, practice activity and demography are associated with the AD prescribing. METHODS: Analysis of AD prescribing patterns among 174 general practices (93.5%) in the County of Funen, Denmark. Age- and sex-standardised 1-year incidences and prevalences of AD prescribing for patients listed were calculated using individual prescription data from Odense University Pharmacoepidemiologic Database. Data about health services and practice demography were obtained from the Health Insurance Register. The variation in AD 1-year prevalence was compared with other drug groups by a variation index (90%/10% percentile). Univariate linear regression analysis was used to examine associations between practice characteristics and prescribing. RESULTS: The 1-year prevalence of AD prescribing varied sixfold, no more than the prevalence of five other drug groups. Practices with high yearly: general prescribing prevalence, mean number of drugs per medicated patient, number of surgery consultations/100 patients and counsellings/100 surgery consultations showed the highest yearly prevalence of AD prescribing. Single-handed practices had higher AD prescribing rates than partnerships. The relative use of selective serotonin re-uptake inhibitors and other new ADs showed only little variation (10% and 90% percentiles as close as 66-86%), but practices with high 1-year prevalence and incidence most often chose the new ADs. CONCLUSION: Analysis of inter-practice variation showed no extraordinary quality problems with regard to AD prescribing, but does not exclude that there might be problems. The general prescribing pattern of the general practitioners seems essential to their attitude to AD prescribing. The relationship between counselling and prescribing was a feature specific to ADs and deserves further investigation. Quality indicators are needed to understand differences in AD prescribing, and studies based on prescription data have to be supplemented with individual clinical data.
PubMed ID
12721774 View in PubMed
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[Cardiovascular risk factors. Different evaluations by physicians and patients]

https://arctichealth.org/en/permalink/ahliterature53634
Source
Ugeskr Laeger. 2002 Nov 11;164(46):5382-6
Publication Type
Article
Date
Nov-11-2002
Author
Lars Bjerrum
Lena R V Hamm
Birgit Toft
Anders P Munck
Jakob Kragstrup
Author Affiliation
Syddansk Universitet, Audit Projekt Odense. lbjerrum@health.sdu.dk
Source
Ugeskr Laeger. 2002 Nov 11;164(46):5382-6
Date
Nov-11-2002
Language
Danish
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Attitude to Health
Cardiovascular Diseases - etiology - prevention & control
Denmark
English Abstract
Humans
Life Style
Middle Aged
Myocardial Ischemia - etiology - prevention & control
Patients - psychology
Physicians, Family - psychology
Questionnaires
Research Support, Non-U.S. Gov't
Risk Assessment - methods
Risk factors
Risk Reduction Behavior
Abstract
INTRODUCTION: General practitioners have an important role in the prevention of cardiovascular disorders, and it is a precondition for motivating patients to preventive issues that doctors are aware of the prevalent risk factors. The aim of the study was to analyse agreement between patients' and general practitioners' (GPs) perception of risk factors and overall risk of ischemic heart diseases (IHD). MATERIAL AND METHODS: The data consisted of records from an audit in May 1999. The GPs (n = 26) registered all enquiries from patients with IHD (n = 252) and a sample of healthy individuals (n = 1239). Both doctors and patients were asked to register the occurrence of cardiovascular risk factors (smoking, weight, stress, family history) and they were asked to evaluate the state of health and to estimate the overall risk of IHD. The agreement was evaluated by Kappa statistics. RESULTS: The level of agreement between GPs and patients varied from 70 to 97 per cent. Disagreement was observed most often for patients with IHD and patients listed with elderly GPs. (> 50 years). Disagreement was predominantly caused by a lower detection rate of the risk factors by the GPs. The patients' perception of overall risk of IHD was badly correlated to doctors' perception. Generally, patients perceived the overall risk of IHD lower than their doctors, and in more than half of the patients with a perception of low risk the GP estimated the risk as high. DISCUSSION: Patients and GPs have different perceptions of the risk of IHD. This may be due to the fact that GPs do not have all the information about their patients' lifestyle. It may also be due to different perception of the importance of specific risk factors and different reference frames for risk perception. GPs have an important role in communicating cardio-preventive issues and the meaning of risk factors. Interventions should be considered to improve risk communication in general practice.
PubMed ID
12469384 View in PubMed
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Consultation with the general practitioner triggered by advice from social network members.

https://arctichealth.org/en/permalink/ahliterature71050
Source
Scand J Prim Health Care. 2004 Mar;22(1):54-9
Publication Type
Article
Date
Mar-2004
Author
Tina Eriksson
Malcolm Maclure
Jakob Kragstrup
Author Affiliation
Research Unit of General Practice, University of Southern Denmark, Odense, Denmark. eriksson@dadlnet.dk
Source
Scand J Prim Health Care. 2004 Mar;22(1):54-9
Date
Mar-2004
Language
English
Publication Type
Article
Keywords
Comparative Study
Cross-Over Studies
Denmark
Family Practice - statistics & numerical data
Female
Friends - psychology
Health Services Research
Humans
Male
Odds Ratio
Patient Acceptance of Health Care - psychology - statistics & numerical data
Persuasive Communication
Primary Health Care - utilization
Social Support
Abstract
OBJECTIVE: To investigate whether advice from a person's social network triggers contact with the general practitioner (GP). DESIGN: Case-crossover design comparing the frequency of advice given to seek medical attention in the period before contact with a GP and the frequency in matching control time periods for the same individual. SETTING: Twenty-one Danish GPs working in single-handed practices. SUBJECTS: 322 patients, aged between 18 and 91 years, were interviewed by telephone after an unscheduled visit to their GP; 148 were interviewed again 3-6 months later. MAIN OUTCOME AND MEASURES: The odds of individuals consulting their GP after receiving advice from network members in the period before they contacted their GP compared with the odds of those consulting their GP in the control period(s). RESULTS: Being advised by others to seek medical attention increased the likelihood of seeking primary health care approximately fivefold--single men received advice significantly less frequently (7%) than women (18%) and cohabiting men (32%). CONCLUSION: Advice from other social network members to seek medical attention is a frequent and influential cue prompting individuals to contact their GP.
PubMed ID
15119522 View in PubMed
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Danish GPs' perception of disease risk and benefit of prevention.

https://arctichealth.org/en/permalink/ahliterature191739
Source
Fam Pract. 2002 Feb;19(1):3-6
Publication Type
Article
Date
Feb-2002
Author
Jørgen Nexøe
Dorte Gyrd-Hansen
Jakob Kragstrup
Ivar Sønbø Kristiansen
Jesper Bo Nielsen
Author Affiliation
Institute of Public Health, University of Southern Denmark, Odense, Winsløwparken 19, DK-5000 Odense C, Denmark.
Source
Fam Pract. 2002 Feb;19(1):3-6
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Denmark
Family Practice
Humans
Preventive Medicine
Risk assessment
Abstract
Uncertainty and risk are central issues in relation to health and health care services. Healthy individuals do not necessarily fall ill, despite the presence of risk factors. It has been documented that doctors, health service administrators and patients are more inclined to choose interventions against risk factors when information about the effects is presented in terms of relative risk reductions rather than absolute risk reductions.
The objective of the study was to gain better insight into how GPs perceive risk of disease, and how this perception is influenced by the way the risk is presented, e.g. whether changes in risk are presented in absolute or relative terms.
Questionnaires with clinical episodes were sent to 1500 Danish GPs. The GPs were randomized into four groups of 375, who all received the same case story with information about risk reduction achieved through medical treatment phrased in terms of either relative risk reduction, absolute risk reduction, number needed to treat or all of the aforementioned terms of risk reduction. The GPs were asked whether they would recommend medical treatment as primary prevention, knowing the case story and expected risk reduction.
The GPs' attitude towards recommending medical treatment was dependent on the phrasing of risk reductions. Seventy-two per cent of doctors who received all information on risk reductions would definitely or probably recommend medication, while 91% would recommend medication if information only about relative risk reduction was given, and 63% would recommend medication if information was given in terms of absolute risk reduction or number needed to treat.
In order to advise patients in a rational way, in addition to knowledge of the patients' preferences, doctors need to take into account all available measures of risk reductions.
PubMed ID
11818342 View in PubMed
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Detailed postal feedback about prescribing to asthma patients combined with a guideline statement showed no impact: a randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature15376
Source
Eur J Clin Pharmacol. 2002 May;58(2):127-32
Publication Type
Article
Date
May-2002
Author
Jens Søndergaard
Morten Andersen
Kirstin Vach
Jakob Kragstrup
Malcolm Maclure
Lars F Gram
Author Affiliation
Research Unit of Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense University, Odense, Denmark. j-soendergaard@cekfo.sdu.dk
Source
Eur J Clin Pharmacol. 2002 May;58(2):127-32
Date
May-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adrenal Cortex Hormones - administration & dosage - therapeutic use
Adrenergic beta-Agonists - administration & dosage - therapeutic use
Adult
Asthma - drug therapy
Child
Denmark
Family Practice
Feedback
Humans
Middle Aged
Physician's Practice Patterns
Postal Service
Practice Guidelines
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: To evaluate the effects of postal feedback with clinically relevant data on general practitioners' prescribing compared with feedback with aggregate data on prescribing patterns of asthma drugs.METHODS: The study was a randomised, controlled trial. The general practitioners (GPs) in the County of Funen, Denmark (292 GPs representing 178 practices) were randomised to one of three groups receiving different forms of prescriber feedback. The first group received detailed and clinically relevant data on asthma drug prescribing patterns and a guideline statement. These data included tables with counts of asthma patients following classification of each individual's consumption of inhaled beta2-agonists and use of inhaled steroids. The second group received aggregate data on asthma drug prescribing patterns and a guideline statement, and the third group received feedback on an unrelated subject and served as control for the other groups. Each GP received prescriber feedback three times within a 6-month period. The last two letters with prescriber feedback had updated information with the purpose of showing changes in prescribing patterns. Effects were followed for a period of 1 year. The main outcome measures were change in fraction of asthmatics treated with inhaled steroids and incidence rate of treatment with inhaled steroids.RESULTS: The three groups had similar baseline characteristics. None of the two types of feedback on prescribing of asthma drugs had a statistically significant impact on GPs' prescribing patterns.CONCLUSION: Mailed prescriber feedback of detailed and clinically relevant data with a guideline statement, without revealing patient identities, has little or no impact on prescribing patterns.
PubMed ID
12012145 View in PubMed
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Does the early adopter of drugs exist? A population-based study of general practitioners' prescribing of new drugs.

https://arctichealth.org/en/permalink/ahliterature177780
Source
Eur J Clin Pharmacol. 2004 Nov;60(9):667-72
Publication Type
Article
Date
Nov-2004
Author
Torben Dybdahl
Morten Andersen
Jens Søndergaard
Jakob Kragstrup
Ivar Sønbø Kristiansen
Author Affiliation
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Winsløwparken 19, 3rd, 5000, Odense C, Denmark. tdybdahl@health.sdu.dk
Source
Eur J Clin Pharmacol. 2004 Nov;60(9):667-72
Date
Nov-2004
Language
English
Publication Type
Article
Keywords
Cohort Studies
Databases, Factual - statistics & numerical data
Decision Making
Denmark
Drug Therapy
Drug Utilization - economics - statistics & numerical data
Family Practice - statistics & numerical data
Humans
Physician's Practice Patterns - statistics & numerical data
Physicians, Family - statistics & numerical data
Time Factors
Abstract
To analyse associations between indicators for adoption of new drugs and to test the hypothesis that physicians' early adoption of new drugs is a personal trait independent of drug groups.
In a population-based cohort study using register data, we analysed the prescribing of new drugs by Danish general practitioners. Angiotensin-II antagonists, triptans, selective cyclo-oxygenase-2 antagonists and esomeprazol were used in the assessment. As indicators of new drug uptake, we used adoption time, cumulative incidence, preference proportion, incidence rate and prescription cost and volume. For each measure, we ranked the general practices. Ranks were pair-wise plotted, and Pearson's correlation coefficient ( r) was calculated. Next, we analysed the correlation between ranks across different drug classes.
For all indicators, the general practitioners' adoption of one group of drugs was poorly associated with adoption of others ( r
Notes
Erratum In: Eur J Clin Pharmacol. 2005 Mar;61(1):75
PubMed ID
15502995 View in PubMed
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Do general practitioner and patient agree about the risk factors for ischaemic heart disease?

https://arctichealth.org/en/permalink/ahliterature49803
Source
Scand J Prim Health Care. 2002 Mar;20(1):16-21
Publication Type
Article
Date
Mar-2002
Author
Lars Bjerrum
Lena Hamm
Birgit Toft
Anders Munck
Jakob Kragstrup
Author Affiliation
Research Unit of General Practice, University of Southern Denmark, Odense. lbjerrum@health.sdu.dk
Source
Scand J Prim Health Care. 2002 Mar;20(1):16-21
Date
Mar-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude of Health Personnel
Attitude to Health
Case-Control Studies
Communication
Cross-Sectional Studies
Denmark - epidemiology
Exercise
Female
Health Knowledge, Attitudes, Practice
Humans
Life Style
Male
Middle Aged
Myocardial Ischemia - epidemiology - etiology - psychology
Obesity - complications
Patient Education
Physician's Role
Physician-Patient Relations
Physicians, Family - psychology
Research Support, Non-U.S. Gov't
Risk assessment
Risk factors
Smoking - adverse effects
Stress, Psychological - complications
Abstract
OBJECTIVE: To analyse agreement between patients' and GPs' perceptions of risk factors and overall risk of ischaemic heart disease (IHD). DESIGN: Cross-sectional study based on paired information from patients and GPs. SETTING: Twenty-six GPs in the County of Ringkøbing, Denmark, participating in a medical audit during 3 weeks in May 1999. SUBJECTS: 252 patients with IHD and 1239 without IHD. MAIN OUTCOME MEASURES: GPs and patients were asked about specific risk factors for IHD and their perception of overall risk. Their agreement was evaluated by Kappa statistics. RESULTS: Agreement between GPs and patients varied from 70% to 97%. Disagreement was observed most often for patients with IHD and patients listed with elderly GPs ( > 50 years). Generally, patients perceived the overall risk of IHD lower than their doctors, and for most patients with a perception of low risk the GP estimated the risk as high. CONCLUSIONS: Patients and GPs have different perceptions of the risk of [HD. This may be due to different perceptions of the importance of specific risk factors and different reference frames for risk perception. GPs have an important role in communicating the meaning of risk factors and interventions should be considered to improve risk communication in general practice.
PubMed ID
12086277 View in PubMed
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Early discontinuation of antidepressants in general practice: association with patient and prescriber characteristics.

https://arctichealth.org/en/permalink/ahliterature45760
Source
Fam Pract. 2004 Dec;21(6):623-9
Publication Type
Article
Date
Dec-2004
Author
Dorte Gilså Hansen
Werner Vach
Jens-Ulrik Rosholm
Jens Søndergaard
Lars F Gram
Jakob Kragstrup
Author Affiliation
Research Unit of General Practice, University of Southern Denmark, Odense, Denmark. DGilsaa@health.sdu.dk
Source
Fam Pract. 2004 Dec;21(6):623-9
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antidepressive Agents - classification - therapeutic use
Antidepressive Agents, Tricyclic - therapeutic use
Denmark
Drug Utilization - statistics & numerical data
Family Practice - standards - statistics & numerical data
Female
Humans
Logistic Models
Male
Middle Aged
Patient Compliance - statistics & numerical data
Physician's Practice Patterns - statistics & numerical data
Prescriptions, Drug
Registries
Research Support, Non-U.S. Gov't
Socioeconomic Factors
Abstract
BACKGROUND: Most antidepressant treatment is initiated and continued in general practice but, despite current guidelines, treatment duration is often short among patients with depression. Discontinuation may, however, be caused by a complexity of factors, but so far research has focused on drug effects, adverse effects and drug regimens. OBJECTIVE: Our aim was to analyse whether early discontinuation of first-time antidepressant treatment in general practice may be predicted by (i) social position and psychiatric history of the patient; and (ii) demography, practice activity and the general prescribing behaviour of the GP. METHODS: Early discontinuation, i.e. that patients do not purchase antidepressants in the 6 months following first prescription, was analysed using established databases. Among patients presenting in 174 general practices in Funen County, Denmark, 4860 adult first-time users of antidepressants were identified (regardless of diagnosis). The inclusion period was January 1998-June 1999. RESULTS: One in three patients did not purchase antidepressants in the 6 months following first prescription, but rates were higher among those prescribed tricyclic compared with new generation antidepressants. Patients' age and sex did not have an influence, but early discontinuation was more frequent among patients of low socio-economic status and patients prescribed in practices characterized by high prescribing rates. No association with psychiatric history was observed. CONCLUSION: Early discontinuation is frequent in general practice, and patients of low social status are at greater risk. Adherence-promoting strategies should pay attention to the high prescribing doctors. Further studies may answer the question of whether the association between doctors' prescribing behaviour and early discontinuation is a feature specific to antidepressants or a more general phenomenon.
PubMed ID
15520034 View in PubMed
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Estimating incidence and prevalence of episodes of care in general practice.

https://arctichealth.org/en/permalink/ahliterature71049
Source
Scand J Prim Health Care. 2004 Mar;22(1):60-4
Publication Type
Article
Date
Mar-2004
Author
Henrik Schroll
Henrik Støvring
Annette Houmand
Jakob Kragstrup
Author Affiliation
Research Unit of General Practice, University of SouthernDenmark, Odense, Denmark. hschroll@health.sdu.dk
Source
Scand J Prim Health Care. 2004 Mar;22(1):60-4
Date
Mar-2004
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Denmark - epidemiology
Episode of Care
Family Practice - statistics & numerical data
Female
Health Services Research
Humans
Hypertension - classification - epidemiology
Incidence
International Classification of Diseases
Longitudinal Studies
Male
Medical Records Systems, Computerized
Prevalence
Registries
Abstract
OBJECTIVES: To develop methods for prospective registration and analysis of episodes of care (one or more contacts about the same health problem). To compare estimates of point prevalence and incidence of hypertension among a group of elderly patients by means of an elaborate coding of episodes and a new method based on routine coding of contact diagnoses. DESIGN: Prospective longitudinal cohort study. SETTING: General practice in Denmark. SUBJECTS: 31 GPs and 1722 patients 70+ years of age. MAIN OUTCOME MEASURES: During the course one year, data were registered in the doctors' electronic medical record systems. Registration included ICPC diagnoses and codes for diagnostic and therapeutic procedures. Individual contacts were linked into episodes of care by the recording physician. Prevalence and incidence were calculated from the GPs' registration of episodes of care and from contact registration by means of a new method, "the waiting time distribution". RESULTS: Estimates of incidence (2.1 per 100 patient years) and point prevalence (21.2 per 100 patients) of episodes of hypertension care could be calculated when the GPs actively linked contacts into episodes. Based on simple contact registration it was possible to calculate similar estimates. CONCLUSION: A full registration of episodes of care is time-consuming and complicated. Incidence and point prevalence of chronic conditions, however, may be estimated from simple coding of contact diagnoses.
PubMed ID
15119523 View in PubMed
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Exposure to potential drug interactions in primary health care.

https://arctichealth.org/en/permalink/ahliterature71243
Source
Scand J Prim Health Care. 2003 Sep;21(3):153-8
Publication Type
Article
Date
Sep-2003
Author
Lars Bjerrum
Morten Andersen
Gert Petersen
Jakob Kragstrup
Author Affiliation
Research Unit of General Practice, University of Southern Denmark, Odense. lbjerrum@health.sdu.dk
Source
Scand J Prim Health Care. 2003 Sep;21(3):153-8
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Denmark - epidemiology
Drug Interactions
Family Practice - statistics & numerical data
Female
Humans
Male
Middle Aged
Polypharmacy
Research Support, Non-U.S. Gov't
Risk factors
Abstract
OBJECTIVE: To analyse the prevalence of potential drug interactions, and to identify patients particularly prone to drug interaction. DESIGN: Database study (Odense University Pharmacoepidemiologic Database). SETTING: Individuals exposed to polypharmacy in 1999 were examined for potential drug interactions. SUBJECTS: Inhabitants of the County of Funen (n = 471 732). MAIN OUTCOME MEASURES: Prevalence of potential drug interactions. RESULTS: One-third of the population were exposed to polypharmacy and among these 15% were exposed to drugs carrying a risk of harmful interaction. Among the elderly with polypharmacy, 25% aged 60-79 years and 36% over 80 years received drugs carrying the risk of interaction. Among individuals exposed to potential drug interaction, 62% were exposed only to one drug interaction and 38% to two or more different drug interactions. The drugs accounting for the highest number of potential interactions were diuretics, NSAIDs, ACE-inhibitors, digoxin, oral antidiabetics, calcium channel blockers, anticoagulants and beta-blockers. When focusing only on major drug interactions, potassium-sparing diuretics and oral anticoagulants were the most frequently involved drugs. CONCLUSION: Elderly patients exposed to polypharmacy should be kept under intensified monitoring as they are at increased risk of clinically significant drug interactions.
PubMed ID
14531506 View in PubMed
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23 records – page 1 of 3.